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Question

Until recovered?

Answer 1

* Emotional abuse * Physical neglect * Sexual abuse * NAI

Answer 2

* 'Frozen watchful' appearance * Expressionless face, wary eyes * Abnormally affectionate to strangers

Answer 3

Sexual abuse may take the form of inappropriate touching, forced expo- sure to sexual acts, vaginal, oral or rectal intercourse and sexual assault. * Anogenital bruising and tears if acute * Pregnancy, sexually transmitted diseases • There may be no physical signs It may come to light if disclosure is made, inappropriate sexual behaviour is exhibited or as a result of trauma or genital infections. Signs of trauma may be found in the mouth, anus or genitalia, but absence of signs is common and fewer than half the victims have any substantiating physical evidence.

Answer 4

• Unkempt dirty appearance * Sores * Uncared for nappy rash * Failure to thrive - principal factor being inadequate nutrition The mother is commonly deprived and unloved herself and often is clinically depressed. The child looks malnourished and uncared for, and immu- nizations are often not up to date. Delays in development are common, and signs of physical abuse may be seen. When admitted to hospital these babies often show rapid weight gain.

Answer 5

Bruises of suspicious shape or site Burns and scalds Bites Hidden head injuries Suspicious fractures Drowsiness Abused children are commonly fearful, aggressive and hyperactive, and many go on to become delin- quent, violent and the next generation of abusers. Children with repeated injury to the CNS may develop brain damage with learning disabilities or epilepsy. Injuries may range in severity from minor bruises to fatal subdural haematomas

Answer 6

* Injuries in very young children. * Explanations which do not match the appearance of the injury, and change. * Multiple types and age of injury. * Injuries which are ‘classic’ in site or character. * Delay in presentation. * Things the child may communicate during the evaluation.

Answer 7

In most cases the abuser is a related carer or male friend of the mother. Most have neither psychotic nor criminal personalities, but tend to be unhappy, lonely, angry adults under stress, who may have experienced child abuse themselves.

Answer 8

Secrecy is often enforced by the offender who is usually male and a family member or acquaintance of the family

Answer 9

**Investigations** o Skeletal survey o CT head scan o Bloods and bone profile Rule out leukaemia, ITP etc. o Fundoscopy(retinal haemorrhages)

Answer 10

**Is the child in DANGER?** o Could the siblings or parents be in danger? o **MAKE SURE THE CHILD IS IN A SAFE PLACE** **Who to get involved?** o Senior colleagues o Named doctor for child protection o Contact social services and make a formal referral o Consider contacting the police (**Child Abuse Investigation Team (CAIT)**) o Consider contacting **Multi-Agency Safeguarding Hub (MASH)** This includes a variety of people that help manage different aspects of a child’s life

Answer 11

We have to talk about what to do next from a medical and non-medical standpoint Whenever we have a case where we don’t know why an injury has occurred, we have to involve some other people This includes social services and the child safeguarding team (and maybe the police) This is a routine requirement for all children in these situations, and our aim is to keep your child safe Sometimes when children have similar injuries, they do not happen by accident and they are caused by someone else

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